Healthcare Provider Details

I. General information

NPI: 1558109892
Provider Name (Legal Business Name): LAURA BETH RUGGIO RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 KEENELAND RD
SAINT JOHNS FL
32259-2363
US

IV. Provider business mailing address

122 KEENELAND RD
SAINT JOHNS FL
32259-2363
US

V. Phone/Fax

Practice location:
  • Phone: 407-885-3779
  • Fax:
Mailing address:
  • Phone: 407-885-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number13398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: